"We only draw blood cultures with fresh sticks"

[NunquamDormio]

Does anyone else work in an ICU where blood cultures can NEVER, EVER be drawn off any type of indwelling line? During an ICU sub-I month in med school, I worked in an ICU where we would aggressively culture off of lines to see whether they were infected. Where I work now, however, it seems like we are trying to "solve" the problem of CLABSI's by making it illegal to check for them.

Is this legal? If so, is it ethical? Seems kind of like "fixing" the problem of speeding by taking away all the radar guns.

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[Hernandez]

They’re both right & wrong at the same time. Over use of cultures from lines leads to over and inappropriate diagnosis of line related infections. Saying never draw cultures from a line is also ridiculously stringent.

 

[POW16]

Same policy where I'm doing a fellowship.

 

[jdh71]

Accessing a central line for lab draws, blood cultures or not, also increases the risk of, line infections. I have no problem with "no line draws" being the starting default, but "never" isn't an acceptable solution to the "CMS and line infection based problem" for hospitals.

 

[sluggs]

If I am lining a patient with suspected sepsis and no cultures have been done; I will draw them from my new CVL and art line.
I agree with JDH about infection risk with lab draws.
First try should be a peripheral stick-- bad vessels may necessitate using a line.
Also: I do not agree with culturing a line to see if there is a CLABSI in an unstable patient... if you have severe sepsis or septic shock without a big honking pneumonia or a strongly positive UTI you need to be thinking about that CVL/port/PICC and get it out. Timely source control (sometimes empirically) is essential!

 

[RNthenDoc]

All about that cheddar

 

[AdmiralChz]

All about that cheddar View attachment 242070

Also can't have ventilator-associated pneumonia (VAP) if you don't ever check sputum / tracheal aspirate cultures!

Right on the money here - all about avoiding on those huge dings from CMS.

 

[deleted875186]

Common in many ICUs. Cut down CAUTIS by decreasing the number of urine cultures sent. Meanwhile if I ask for people’s Foley’s to be taken out when, I’ll get pushback from the nurses. Never culture a line and you don’t have a CLABSI. Never label a pneumonia a VAP, instead write pneumonia due to pseudomonas. The list goes on and on. It makes all these quality measures near meaningless.

 

[Siggy]

Meanwhile if I ask for people’s Foley’s to be taken out when, I’ll get pushback from the nurses.

My fellowship hospital is bizarro world. It's the only place I've been in where I've had to fight to get a foley put in, and then every day at MDR the infection control nurse is badgering us to remove it. However we also have an external female "catheter" and use a lot of condom caths for men.

 

[deleted875186]

My fellowship hospital is bizarro world. It's the only place I've been in where I've had to fight to get a foley put in, and then every day at MDR the infection control nurse is badgering us to remove it. However we also have an external female "catheter" and use a lot of condom caths for men.

Sometimes I feel as though the hospital treats a CAUTI as if it were a as bad as a massive PE or something.

 

[SurfingDoctor]

Sometimes I feel as though the hospital treats a CAUTI as if it were a as bad as a massive PE or something.

It looks pretty bad when a patient dies of VRE urosepsis who didn't need a foley... same as it looks pretty bad when a patient dies of a saddle embolus who wasn't on SubQ Heparin when they weren't ambulatory...

Preventable hospital-acquired death is always a suboptimal outcome... no matter the cause.

 

[McPoyle]

It looks pretty bad when a patient dies of VRE urosepsis who didn't need a foley... same as it looks pretty bad when a patient dies of a saddle embolus who wasn't on SubQ Heparin when they weren't ambulatory...

Preventable hospital-acquired death is always a suboptimal outcome... no matter the cause.

This is my feeling, if it’s preventable and I can do something to lower the incidence rate then I’ll of course push to get Foleys out. Beyond that I think there are other benefits to getting them out, patients can move easier and lessening discomfort can lessen delirium and agitation. Why not minimize lines, tubes, and drains?


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[RNthenDoc]

About 95% of the time I agree with the above. The fewer the lines the better.

There are cases where patients (especially with delirium, incontinence, diuretics, and skin breakdown with unstageable ulcers) benefit MUCH more from leaving something in, though. I think we need to leave room for physicians to make decisions, and not *just* do everything by protocol. I've unfortunately seen peri wounds turn into fatal sepsis that I think might have been avoided if we weren't such line nazis. Again, I'm sure this is the rare exception, though.



Kinda' like how so many patients are committing suicide because we are applying broad tapers/cutoff protocols to opioids, and some people have legitimate need for them. But that's a whole other soapbox for somebody other than an ol' ICU nurse to talk about.